Italy: Valentina, who had no choice but to die from a miscarriage

The story of the death of Valentina Milluzzo, a young woman from Catania, Sicily, in the 19th week of a pregnancy with twins

by Elisabetta Canitano, Gynaecologist and Chair of the Association “Vita di Donna” (Women’s Lives) of Rome

“The child’s heart is still beating.” Throughout Italy in religiously-affiliated maternity wards, and birth centres where religion is predominant, that phrase is used to put women at risk.

Still. “Still”, referring to a pregnancy that is fatally compromised but the fetal heart continues to beat. For women between the 16th and 22nd week of pregnancy, with fetuses that are incompatible with survival, this phrase carries the risk of a death sentence every day. Because women might not get an immediate abortion to save their lives, as recommended by international medical guidelines.

Most of these women at risk have a ruptured gestational sac. We don’t know for sure if that happened in Valentina’s case, but apparently her cervix had prematurely dilated, creating a threat of miscarriage, and it’s known that she had a high fever at least 12 hours before she delivered the first stillborn twin – already dead for some time. Bacteria must have found an open path into her uterus many hours before. When the uterine cavity is in direct contact with the outside environment, it creates the risk of a dangerous infection called septicaemia, nowadays called sepsis. And sepsis happens frequently if the pregnancy is not terminated without delay. In rare cases, the heartbeat stops or contractions begin unaided, and the woman’s body is able to empty itself without further incident. But, for each hour the unviable fetus is left inside by those saying “we can’t intervene, there’s a heartbeat”, the risk of fatal sepsis increases.

What to do then? Where doctors apply the 194/78 law, they explain to women that their wanted child cannot be born and, in fact, threatens to kill them. A therapeutic abortion is recommended and done without delay to save the woman’s life.

At some religious hospitals, the doctors will call a public hospital to arrange a transfer of the woman for an abortion elsewhere. But they avoid their responsibility of care by means of a dubious document, telling the woman: “Sign this to confirm that you leave on your own authority to get help at this other hospital.” The doctors’ essential obligation to protect the women’s life has been dishonourably put on the shoulders of the public hospital.

In public hospitals, things proceed normally without much bureaucracy. Doctors tell the woman “inducing abortion is the best thing as there’s no further hope for the fetus, and waiting will risk your life”, just as when urgent caesareans are performed on women at any week of gestation with acute eclampsia (convulsions from gestational toxicosis).

And then someone pushes the envelope further. Valentina has an intermittent maternal fever, an ominous sign of sepsis, but it doesn’t matter. (In the morning, did the nurse call the doctor to tell him? Who decided to give Tylenol (a simple painkiller, the nurse alone?). The patient’s temperature is 34 degrees, blood pressure is 50/70, alarmingly low, but no matter.

An examination – the one that head physician Doctor Scollo is so proud of as a modern scientific success – is performed and shows the infection is spreading. But it doesn’t matter.

There are atrocious pains, screaming, shivering. To the point that she doesn’t want to leave the bed and go to the delivery room. Valentina’s mother slaps her to revive her, she’s already fainted three times that morning.

None of these signs, terrifyingly clear signs of life-threatening sepsis since that morning, enter the conscious perception of the “conscientious objector” doctor.

Locked in his phrase, “There’s still a heartbeat”, he’s practically a robot. He says nonsense like “there’s a renal colic,” “these are just labour pains,” to deny to himself that he’s putting her life at risk, something that would obligate him to help her. This lack of recognition of basic facts is what always puts women at risk.

He could call the doctor who performs abortions in that hospital as a consultant and have that doctor assist her. But to take this step, he would have to recognize the harm he’s doing, the risk that he inflicts upon women every day in the name of a mantra devoid of any clinical sense.

So the hours pass by, destroying Valentina’s life. With sepsis, even twenty minutes can make a difference between life and death. One must call the anaesthetist immediately and undertake urgent life-saving treatment, otherwise the infection will begin to destroy the liver, the kidneys, the brain, the immune system, the circulatory system.

Valentina feels these terrible pains caused by the destruction of her organs, and shouts them at those who have no ears to hear nor heart to pity her.

There are twins and the doctor says: “Even if only one fetal heart is beating, I can do nothing.” And meanwhile, Valentina is dying. She has been left to die in agony since morning.

At the end, she asks her mother for sedation, she feels what’s happening. She asks, at least, not to suffer any more. Everything is denied to her, including the treatment of pain.

From 9 in the morning, when her fever first rose, she expels the first fetus at 11pm, after her body had literally been eaten by the sepsis. After the expulsion of the second fetus, also dead, there is nothing left for her but to die.

And for us, there is nothing left but the sorrow, the rage, and the promise that this must never happen again to other women.

FURTHER INFORMATION: Preliminary report from the Board of Health, 24 October 2016, appears to exonerate everyone involved in the hospital. This report has already been called into question by three Italian medical professionals in informal comments below the report.

EDITOR’S NOTE: Valentina was in the hospital miscarrying an unviable pregnancy from 29 September until her death on 16 October. This is unconscionable. It isn’t just what happened in the last 12 hours of her life that killed her, but what happened the whole time. Early intervention would have prevented what happened in the last 12 hours. Whether it was clinical incompetence or negligence, or lack of understanding or experience of why this was an emergency obstetric case the minute she entered the hospital, or whether it involved individuals’ refusal to carry out a termination on grounds of conscience or on grounds of an unspoken or unacknowledged hospital policy to adhere to Catholic health policy – or a combination of one or more of these – she died unnecessarily. Without an independent investigation, we cannot know which of these was actually operative, and without that information the risk of this happening to more women in Italy is increased. It would appear from this article that this risk is already present and known.